Evaluating the Additional Value of Endoscopic Ultrasonography for Depth Assessment of Esophagogastric Junction Adenocarcinoma

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Objectives: Endoscopic ultrasonography (EUS) is sometimes used to assess the depth of invasion in esophagogastric junction adenocarcinoma (EGJA); however, its diagnostic performance in EGJA remains unclear. This study aimed to evaluate the additional value of EUS to conventional endoscopy (CE) in assessing invasion depth. Methods: In this single-institution retrospective study, we compared the diagnostic performance of CE alone with that of CE + EUS for preoperative depth assessment of early-stage EGJA. In addition, we examined the clinicopathologic features associated with incorrect depth assessment. Results: The study included 93 cases of early-stage EGJA. Comparing the diagnostic performance for diagnosing submucosal cancer (CE vs. CE + EUS), CE + EUS had a significantly lower specificity than CE alone (78.4% vs. 62.2%). However, no significant differences were observed in sensitivity (73.2% vs. 71.4%) and accuracy (75.3% vs. 67.7%) between the two modalities. The addition of EUS was associated with significantly higher misdiagnosis rates in the following types of lesions: lesions located on the esophageal side (42.6% vs. 25.5%), elevated lesions (29.2% vs. 15.4%), complex lesions (32.7% vs. 16.3%), and lesions with hiatal hernia (31.1% vs. 19.7%). No clinicopathological factors were significantly associated with overdiagnosis or underdiagnosis. Conclusions: The addition of EUS to CE reduced the ability to accurately identify mucosal cancers in early-stage EGJA, suggesting a risk of overdiagnosis and unnecessary therapeutic escalation.

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